Innere Medizin (Heidelberg, Germany)最新文献

The development of a cholecystocolic fistula as a complication of chronic cholecystitis and/or cholangitis is very rare and is difficult to detect without modern imaging. Nevertheless, acute abdominal symptoms are a frequent cause of patient presentation to an emergency department. The present case demonstrates that chronic cholecystitis with corresponding complications can present even without cholestasis and infection.

The article begins with a reflection on the intertwined nature of life and death; this reflection should also serve to sensitize us to the proactive and reactive expressions of a person's life at the end of life. It will be shown that attachment to life can also manifest itself in the case of depression, fear and exhaustion: One must not lose sight of their potential existence. The existing commitment to life allows us to better understand why the remaining time of life may be perceived as something precious; this may be in contrast to statements made in the living will. A distinction is made between subjectively, objectively and socially defined criteria for a good life in the borderline situation of a serious illness leading to death; their comparison is central to the end-of-life decision-making process. In addition to physical and neurocognitive illnesses, suicidality is at the centre of the article.

Bisalbuminemia is characterized by two albumin peaks in the electrophoresis of serum. There are different forms of bisalbuminemia: inherited and acquired. The acquired form is mainly transitory, whereas the familial form is permanent. The frequency of bisalbuminemia in the general population has been reported to be between 0.0003 and 0.01%. This paper presents a case of familial bisalbuminemia as well as the family tree-to the extent obtainable. A married couple, in which the husband had bisalbuminemia, had seven children and 18 grandchildren. Bisalbuminemia was also found in two children and in two grandchildren.

Background: Ethical decision-making is a cornerstone of intensive care and emergency medicine. In acute scenarios, clinicians often face rapid, high-stakes decisions concerning life and death, made more challenging by time constraints and incomplete information. These decisions are further complicated by economic constraints, limited resources, and evolving technological capabilities.

Question: What decision-making aids and factors can be employed in ethical borderline cases within intensive care medicine?

Results: Fundamental ethical principles such as patient autonomy, beneficence, non-maleficence, and justice form the basis for medical treatment decisions. Evaluating the patient's will through advanced directives or proxy consensus is crucial, although advanced directives can be ambiguous. Assessing quality of life is increasingly important, with instruments such as the Clinical Frailty Scale (CFS) being utilized. For older patients, a holistic approach is recommended, focusing on overall health rather than chronological age. In patients with advanced underlying diseases, a multidisciplinary dialogue is essential.

Discussion: Decision-making in intensive care medicine requires careful consideration of medical, ethical, and individual factors. Despite advances in artificial intelligence and prognostic models, human judgment remains crucial. During periods of resource scarcity, ethically sound triage protocols are required. The challenge lies in applying these principles and factors in clinical practice while respecting the individuality of each patient.

The case of a male patient with newly diagnosed polycythemia vera showing rare and unusually rapid progression with phenotypic change towards chronic myelomonocytic leukemia is presented. The case report illustrates remarkably rapid disease progression including a structural change in usually indolent polycythemia vera and highlights the prognostic relevance of enhanced molecular genetic testing.